Instilling Confidence In Your Children

It takes confidence to be a youngster. Whether going to a new school or stepping up to bat for the first time, children face a lot of uncharted territory.

Naturally, moms & dads want to instill a can-do attitude in their children so that they'll bravely take on new challenges and, over time, believe in themselves. While each child is a little different, moms & dads can follow some general guidelines to build children' confidence.

Self-confidence rises out of a sense of competence. In other words, children develop confidence not because moms & dads tell them they're great, but because of their achievements, big and small. Sure, it's good to hear encouraging words from mom and dad. But words of praise mean more when they refer to a child's specific efforts or new abilities.

When children achieve something, whether it's brushing their own teeth or riding a bike, they get a sense of themselves as able and capable, and tap into that high-octane fuel of confidence.

Building self-confidence can begin very early. When babies learn to turn the pages of a book or toddlers learn to walk, they are getting the idea "I can do it!" With each new skill and milestone, children can develop increasing confidence.

Moms & dads can help by giving children lots of opportunities to practice and master their skills, letting children make mistakes and being there to boost their spirits so they keep trying. Respond with interest and excitement when children show off a new skill, and reward them with praise when they achieve a goal or make a good effort.

With plentiful opportunities, good instruction, and lots of patience from moms & dads, children can master basic skills — like tying their shoes and making the bed. Then, when other important challenges present themselves, children can approach them knowing that they have already been successful in other areas.

Stay on the Sidelines

Of course, supervision is important to ensure that children stay safe. But to help them really learn a new skill, it's also important not to hover. Give children the opportunity to try something new, make mistakes, and learn from them.

For instance, if your son wants to learn how to make a peanut butter sandwich, demonstrate, set up the ingredients, and let him give it a try. Will he make a bit of a mess? Almost certainly. But don't swoop in the second some jelly hits the countertop. In fact, avoid any criticism that could discourage him from trying again. If you step in to finish the sandwich, your son will think, "Oh well, I guess I can't make sandwiches."

But if you have patience for the mess and the time it takes to learn, the payoff will be real. Someday soon he'll be able to say, "I'm hungry for lunch, so I'm going to make my own sandwich." You might even reply, "Great, can you make me one, too?" What a clear sign of your faith in his abilities!

Offer Encouragement and Praise

Sometimes, it won't be you swooping in when your child falters, but your child giving up. Help by encouraging persistence in the midst of frustration. By trying again, children learn that obstacles can be overcome.

Once children reach a goal, you'll want to praise not only the end result but also their willingness to stick with it. For instance, after your son has mastered making that peanut butter sandwich you might show your confidence by saying, "Next time, want to learn how to crack an egg?" Sandwich-fixing and egg-cracking might not seem like huge achievements, but they're important steps in the right direction — toward your child's independence.

Throughout childhood, moms & dads have chances to prepare children to take care of themselves. Sure, it's great to feel needed, but as children steadily gain confidence and independence, their relationship with you can be even richer. You can be bonded, not just by dependence, but by love and shared pride in all they've achieved. Eventually, your grown-up children just might say thanks for how prepared they feel for the road ahead — a road they can take with confidence.

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Bipolar In Kids & Teens

Kids and adolescents with Bipolar have manic and/or depressive symptoms. Some may have mostly depression and others a combination of manic and depressive symptoms. Highs may alternate with lows.

Research has improved the ability to diagnose Bipolar in kids and teens. Bipolar can begin in childhood and during the teenage years, although it is usually diagnosed in adult life. The illness can affect anyone. However, if one or both parents have Bipolar, the chances are greater that their kids may develop the disorder. Family history of drug or alcohol abuse also may be associated with greater risk for Bipolar.

Manic symptoms include:

· distractibility - the teen's attention moves constantly from one thing to the next

· great increase in energy and the ability to go with little or no sleep for days without feeling tired

· increase in talking - the adolescent talks too much, too fast, changes topics too quickly, and cannot be interrupted

· repeated high risk-taking behavior; such as, abusing alcohol and drugs, reckless driving, or sexual promiscuity

· severe changes in mood-either unusually happy or silly, or very irritable, angry, agitated or aggressive

· unrealistic highs in self-esteem - for example, a teenager who feels all powerful or like a superhero with special powers

Depressive symptoms include:

· frequent complaints of physical illnesses such as headaches or stomach aches

· irritability, depressed mood, persistent sadness, frequent crying

· loss of enjoyment in favorite activities

· low energy level, fatigue, poor concentration, complaints of boredom

· major change in eating or sleeping patterns, such as oversleeping or overeating

· thoughts of death or suicide

Some of these signs are similar to those that occur in adolescents with other problems such as drug abuse, delinquency, attention-deficit hyperactivity disorder, or even schizophrenia.

Adolescents with Bipolar can be effectively treated. Treatment for Bipolar usually includes education of the patient and the family about the illness, mood stabilizing medications such as lithium and valproic acid, and psychotherapy. Mood stabilizing medications often reduce the number and severity of manic episodes, and also help to prevent depression. Psychotherapy helps the child understand himself or herself, adapt to stresses, rebuild self-esteem and improve relationships.

The diagnosis of Bipolar in kids and teens is complex and involves careful observation over an extended period of time. A thorough evaluation by a child and adolescent psychiatrist identify Bipolar and start treatment.



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Dealing With Anger: Toddlers & Older Children

Toddlers—

Your toddler's second temper tantrum of the day shows no signs of stopping, and supersonic, ear-shattering, teeth-jarring screams pierce the air. You'd run away and join the circus if only that were a real option. There must be a better way.

During the kicking-and-screaming chaos of the moment, anger problems can be downright frustrating. But instead of looking at them as catastrophes, treat anger problems as opportunities for education.

Why Do Children Have Anger problems?

Rage attacks range from whining and crying to screaming, kicking, hitting, and breath holding. They're equally common in boys and girls and usually occur between the ages of 1 to 3.

Children's temperaments vary dramatically — so some children may experience regular anger problems, whereas others have them rarely. They're a normal part of development and don't have to be seen as something negative. Unlike adults, children don't have the same inhibitions or control.

Imagine how it feels when you're determined to program your DVD player and aren't able to do it, no matter how hard you try, because you can't understand how. It's pretty frustrating — do you swear, throw the manual, walk away, and slam the door on your way out? That's the adult version of a tantrum. Toddlers are also trying to master their world and when they aren't able to accomplish a task, they turn to one of the only tools at their disposal for venting frustration — a tantrum.

Several basic causes of anger problems are familiar to moms & dads everywhere: The youngster is seeking attention or is tired, hungry, or uncomfortable. In addition, anger problems are often the result of children' frustration with the world — they can't get something (for example, an object or a parent) to do what they want. Frustration is an unavoidable part of their lives as they learn how people, objects, and their own bodies work.

Anger problems are common during the second year of life, a time when youngsters are acquiring language. Toddlers generally understand more than they can express. Imagine not being able to communicate your needs to someone — a frustrating experience that may precipitate a tantrum. As language skills improve, anger problems tend to decrease.

Another task toddlers are faced with is an increasing need for autonomy. Toddlers want a sense of independence and control over the environment — more than they may be capable of handling. This creates the perfect condition for power struggles as a youngster thinks "I can do it myself" or "I want it, give it to me." When children discover that they can't do it and can't have everything they want, the stage is set for a tantrum.

Avoiding Anger problems Altogether

The best way to deal with rage attacks is to avoid them in the first place, whenever possible. Here are some strategies that may help:

· Consider the request carefully when your youngster wants something. Is it outrageous? Maybe it isn't. Choose your battles; accommodate when you can.

· Distract your youngster. Take advantage of your little one's short attention span by offering a replacement for the coveted object or beginning a new activity to replace the frustrating or forbidden one. Or simply change the environment. Take your toddler outside or inside or move to a different room.

· Keep off-limits objects out of sight and out of reach to make struggles less likely to develop over them. Obviously, this isn't always possible, especially outside of the home where the environment can't be controlled.

· Know your youngster's limits. If you know your toddler is tired, it's not the best time to go grocery shopping or try to squeeze in one more errand.

· Make sure your youngster isn't acting up simply because he or she isn't getting enough attention. To a youngster, negative attention (a parent's response to a tantrum) is better than no attention at all. Try to establish a habit of catching your youngster being good ("time in"), which means rewarding your little one with attention for positive behavior.

· Set the stage for success when children are playing or trying to master a new task. Offer age-appropriate toys and games. Also, start with something simple before moving on to more challenging tasks.

· Try to give toddlers some control over little things. This may fulfill the need for independence and ward off anger problems. Offer minor choices such as "Do you want orange juice or apple juice?" or "Do you want to brush your teeth before or after taking a bath?" This way, you aren't asking "Do you want to brush your teeth now?" — which inevitably will be answered "no."

If a safety issue is involved and a toddler repeats the forbidden behavior after being told to stop, use a time-out or hold the youngster firmly for several minutes. Be consistent. Children must understand that you are inflexible on safety issues.

Tantrum Tactics

The most important thing to keep in mind when you're faced with a youngster in the throes of a tantrum, no matter what the cause, is simple and crucial: Keep cool. Don't complicate the problem with your own frustration. Children can sense when moms & dads are becoming frustrated. This can just make their frustration worse, and you may have a more exaggerated tantrum on your hands. Instead, take deep breaths and try to think clearly.

Your youngster relies on you to be the example. Hitting and spanking don't help; physical tactics send the message that using force and physical punishment is OK. Instead, have enough self-control for both of you.

First, try to understand what's going on. Anger problems should be handled differently depending on the cause. Try to understand where your youngster is coming from. For example, if your little one has just had a great disappointment, you may need to provide comfort.

It's a different situation when the tantrum stems from a youngster's being refused something. Toddlers have fairly rudimentary reasoning skills, so you aren't likely to get far with explanations. Ignoring the outburst is one way to handle it — if the tantrum poses no threat to your youngster or others. Continue your activities, paying no attention to your youngster but remaining within sight. Don't leave your little one alone, though, otherwise he or she may feel abandoned on top of all of the other uncontrollable emotions.

Children who are in danger of hurting themselves or others during a tantrum should be taken to a quiet, safe place to calm down. This also applies to anger problems in public places.

Older children are more likely to use anger problems to get their way if they've learned that this behavior works. Once children are school age, it's appropriate to send them to their rooms to cool off. Rather than setting a specific time limit, moms & dads can tell them to stay in the room until they've has regained control. The former option is empowering — children can affect the outcome by their own actions, thereby gaining a sense of control that was lost during the tantrum.

After the Storm

Occasionally a youngster will have a hard time stopping a tantrum. In these cases, it might help to say to say, "I'll help you settle down now."

But do not reward your youngster after a tantrum by giving in. This will only prove to your little one that the tantrum was effective. Instead, verbally praise a youngster for regaining control.

Also, children may be especially vulnerable after a tantrum when they know they've been less than adorable. Now is the time for a hug and reassurance that your youngster is loved, no matter what.

When to Call the Doctor

You should consult your doctor if:

· The anger problems arouse a lot of bad feelings.
· The anger problems increase in frequency, intensity, or duration.
· You have questions about what you're doing or what your youngster is doing.
· You keep giving in.
· Your youngster displays mood disorders such as negativity, low self-esteem, or extreme dependence.
· Your youngster frequently hurts himself or herself or others.
· Your youngster is destructive.
· You're uncomfortable with your responses.

Your doctor can also check for any physical problems that may be contributing to the anger problems, although this is not common. These include hearing or vision problems, a chronic illness, language delays, or a learning disability.

Remember, anger problems usually aren't cause for concern and generally diminish on their own. As children mature developmentally and their grasp of themselves and the world increases, their frustration levels decrease. Less frustration and more control mean fewer anger problems — and happier moms & dads.

After The Toddler Years—

Moms & dads expect rage attacks from 2-year-olds, but angry outbursts don’t necessarily stop after the toddler years. Older children sometimes have trouble handling anger and frustration, too.

Some children only lose their cool on occasion. But others seem to have a harder time when things don’t go their way. Children who tend to have strong reactions by nature will need more help from moms & dads to manage their tempers.

Controlling outbursts can be difficult for children — and helping them learn to do so is a tough job for the moms & dads who love them. Try to be patient and positive, and know that these skills take time to develop and that just about every youngster can improve with the right coaching.

A Parent’s Role

Managing children — whether it’s one or more — can be a challenge. Some days keeping the peace while keeping your cool seems impossible. But whether you’re reacting to an occasional temper flare-up or a pattern of outbursts, managing your own anger when things get heated will make it easier to teach children to do the same.

To help tame a temper, try to be your youngster’s ally — you're both rooting for your youngster to triumph over the temper that keeps getting him or her into trouble.

While your own patience may be frayed by angry outbursts, opposition, defiance, arguing, and talking back, it’s during these episodes that you need your patience most. Of course you feel angry, but what counts is how you handle that.

Reacting to your youngster’s meltdowns with yelling and outbursts of your own will only teach your youngster to do the same. But keeping your cool and calmly working through a frustrating situation lets you show — and teach — your youngster appropriate ways to handle anger and frustration.

Let’s say you hear your children fighting over a toy in the other room. You have ignored it, hoping that they would work it out themselves. But the arguing turns into screaming, and soon you hear doors slamming, the thump of hitting, and an eruption into tears. You decide to get involved before someone gets hurt.

By the time you arrive at the scene of the fight, you may be at the end of your own rope. After all, the sound of screaming is upsetting, and you may be frustrated that your children aren’t sharing or trying to get along. (And you know that this toy they’re fighting over is going to be lost, broken, or ignored before long anyway!)

So what’s the best way for you to react? With your own self-control intact. Teaching by example is your most powerful tool. Speak calmly, clearly, and firmly — not with anger, blame, harsh criticisms, threats, or putdowns. Of course, that’s easier said than done. But remember that you’re trying to teach your youngster how to handle anger. If you yell or threaten, you'll model and ingrain the exact kinds of behavior you want to discourage. Your youngster sees you so angry and so incapable of controlling your own temper that you can’t help but scream — and that won’t help your youngster learn not to scream.

What You Can Do

Regulating emotions and managing behavior are skills that develop slowly over time during childhood. Just like any other skills, your youngster will need to learn and practice them, with your help.

If it’s uncharacteristic for your youngster to have a tantrum, on the rare occasion that it happens all you may need to do is clearly but calmly review the rules. "I know you’re upset, but no yelling and no name-calling, please" may be all your youngster needs to gain composure. Follow up by clearly, calmly, and patiently giving an instruction like "tell me what you’re upset about" or "please apologize to your brother for calling him that name." In this way, you’re guiding your youngster back to acceptable behavior and encouraging self-control.

Children whose temper outbursts are routine may lack the necessary self-control to deal with frustration and anger, and may need more help managing those emotions. These steps may help:

Create clear ground rules and stick to them. Set and maintain clear expectations for what is and what is not acceptable. You can do this without using threats, accusations, or putdowns. Your youngster will get the message if you make clear, simple statements about what’s off limits and explain what you want him or her to do. You might say: "There’s no yelling in this house. Use your words to tell me what’s upsetting you." Or try these:

· You may not throw things or break things on purpose.
· We don’t do that in this family.
· There's no door-slamming in our house.
· There’s no screaming allowed.
· There’s no name calling.
· In this family, we don’t hit or push or shove.

Listen and respond. Once your youngster puts the feelings into words, it’s up to you to listen and say that you understand. If your youngster is struggling for words, offer some help: "so that made you angry," "you must have felt frustrated," or "that must have hurt your feelings." Offer to help find an answer if there’s a problem to be solved, a conflict to be mended, or if an apology is required. Many times, feeling listened to and understood is all children need to regain their composure. But while acknowledging your youngster's feelings, it’s important to make it clear that strong emotions aren’t an excuse for unacceptable behavior. "I know you’re mad, but it’s still not OK to hit." Then tell your youngster some things to try instead.

Help your youngster put it into words. If your youngster is in the midst of an outburst, find out what’s wrong. If necessary, use a time-out to get your youngster to settle down, or calmly issue a reminder about house rules and expectations — "There’s no yelling or throwing stuff; please stop that right now and cool your jets." Remind your youngster to talk to you without whining, sulking, or yelling. Once your youngster calms down, ask what got him or her so upset. You might say, "Use your words to tell me what’s wrong and what you’re mad about." By doing this you help your youngster put emotions into words and figure out what, if anything, needs to be done to solve the problem.

Coping Strategies for Your Youngster

Children who've learned that it’s not OK to yell, hit, and throw stuff when they're upset need other strategies for calming down when they're angry. Offer some ideas to help your youngster learn safe ways to get the anger out or to find other activities that can create a better mood.

Find a way to (safely) get the anger out. There may be no punching walls or even pillows, but you can suggest some good ways for a youngster to vent. Doing a bunch of jumping jacks, dancing around the bedroom, or going outside and doing cartwheels are all good choices. Or your youngster can choose to write about or draw a picture of what is so upsetting.

Learn to shift. This one is tough for children — and adults, too. Explain that part of calming down is moving from a really angry mood to a more in-control mood. Instead of thinking of the person or situation that caused the anger, encourage your son or daughter to think of something else to do. Suggest things to think of or do that might bring about a better mood. Your youngster may feel better after a walk around the block, a bike ride, playing a game, reading a favorite book, digging in the garden, or listening to a favorite song. Try one of these things together so you both experience how doing something different can change the way a person feels.

Take a break from the situation. Tell your youngster that it’s OK to walk away from a conflict to avoid an angry outburst. By moving to another part of the house or the backyard, your youngster can get some space and work on calming down.

Building a Strong Foundation

Fortunately, really angry episodes don’t happen too often for most children. Those with temper troubles often have an active, strong-willed style and extra energy that needs to be discharged. Try these steps during the calm times — they can prevent problems before they start by helping your youngster learn and practice skills needed to manage the heat of the moment:

Encourage your youngster to take control. Compare a temper to a puppy that hasn’t yet learned to behave and that’s running around all over the place getting into things. Puppies might not mean to be bad — but they need to be trained so that they can learn that there’s no eating shoes, no jumping on people or certain furniture, etc. The point is that your youngster’s temper — like a puppy — needs to be trained to learn when it’s OK to play, how to use all that rambunctious energy, and how to follow rules.

Help your youngster label emotions. Help your youngster get in the habit of saying what he or she is feeling and why — for example, "I'm mad because I have to clean my room while my friends are playing." Using words doesn’t get your youngster out of doing a chore, but having the discussion can defuse the situation. You’re having a conversation instead of an argument. Praise your youngster for talking about it instead of slamming the door, for instance.

See that your youngster gets a lot of physical activity. Active play can really help children who have big tempers. Encourage outside play and sports your youngster likes. Karate, wrestling, and running can be especially good for children who are trying to get their tempers under control. But any activity that gets the heart pumping can help burn off energy and stress.

Try to be flexible. Parenting can be a fatiguing experience, but try not to be too rigid. Hearing a constant chorus of "no" can be disheartening for children. Sometimes, of course, "no" is absolutely the only answer — "no, you can’t ride your bike without your helmet!" But other times, you might let the children win one. For instance, if your youngster wants to keep the wiffle ball game going a little longer, maybe give it 15 more minutes.

As anyone who’s been really angry knows, following sensible advice can be tough when emotions run high. Give your youngster responsibility for getting under control, but be there to remind him or her of how to do it.

Most children can learn to get better at handling anger and frustration. But if your youngster frequently gets into fights and arguments with friends, siblings, and adults, additional help might be needed. Talk with the other adults in your youngster’s life — teachers, school counselors, and coaches might be able to help, and your youngster’s doctor can recommend a counselor or psychologist.

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Seeking Help For Your Child

When To Seek Help For Your Child—

Moms & dads are usually the first to recognize that their youngster has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a mother or father. The first step is to gently try to talk to the youngster. An honest open talk about feelings can often help. Moms & dads may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the youngster well. These steps may resolve the problems for the youngster and family.

Following are a few signs, which may indicate that a child and teen psychiatric evaluation will be useful.

YOUNGER KIDS

· Frequent, unexplainable temper tantrums.
· Hyperactivity; fidgeting; constant movement beyond regular playing.
· Marked fall in school performance.
· Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
· Persistent nightmares.
· Poor grades in school despite trying very hard.
· Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the youngster's age.

PRE-TEENS AND ADOLESCENTS

· Abuse of alcohol and/or drugs.
· Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
· Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death.
· Frequent outbursts of anger, aggression.
· Frequent physical complaints.
· Inability to cope with problems and daily activities.
· Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating.
· Marked change in school performance.
· Marked changes in sleeping and/or eating habits.
· Persistent nightmares.
· Self-injury or self-destructive behavior.
· Sexual acting out.
· Strange thoughts, beliefs, feelings, or unusual behaviors.
· Threats of self-harm or harm to others.
· Threats to run away.

Moms & dads are often in the best position to recognize when their youngster is having a problem. Even when moms & dads do recognize that their youngster is having trouble, it is not always apparent that professional help is necessary.

The first step in assessing the cause of your youngster's difficulty is to ask him. Sometimes, gently asking your youngster questions...

- Why are you constantly sad?
- Why are you so mad?
- Why did you steal that toy from Jake's house?
- You seem upset, is something bothering you?

...will reveal the issues with which he's struggling. Giving him adequate time to respond is necessary; talking honestly with your youngster about his feelings may also be helpful.

Consulting your child's physician or teacher, or your minister, priest, or rabbi may help you identify problems both in the youngster and within the family that could be causing the upset. Frequently, a teacher will notice your youngster's trouble and call you in. Working together, you can often get the youngster back on track before schoolwork or social interaction is affected.

As a rule, it is the combination of moms & dads' growing concerns and the observation of outsiders such as teachers, physicians, and family members, that lead moms & dads to consult a clinician for their youngster. There are a few signs, when present over an extended period time, that indicate that your youngster has problems which could benefit from treatment.

Where To Find Help For Your Child—

Moms & dads are often concerned about their youngster's emotional health or behavior but they don't know where to start to get help. The mental health system can sometimes be complicated and difficult for moms & dads to understand. A youngster's emotional distress often causes disruption to both the parent's and the youngster's world. Moms & dads may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them.

If you are worried about your youngster's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your youngster needs help, you should get as much information as possible about where to find help for your youngster. Moms & dads should be cautious about using Yellow Pages phone directories as their only source of information and referral. Other sources of information include:

· National professional organizations (American Academy of Child and Teen Psychiatry, American Psychiatric Association)

· National Advocacy Organizations (National Alliance for the Mentally Ill, Federation of Families for Kids's Mental Health, National Mental Health Association)

· Local mental health association

· Local medical society, local psychiatric society

· Local hospitals or medical centers with psychiatric services

· Employee Assistance Program through your employer

· Department of Psychiatry in nearby medical school

· County mental health department

The variety of mental health practitioners can be confusing. There are psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, counselors, pastoral counselors and people who call themselves therapists. Few states regulate the practice of psychotherapy, so almost anyone can call herself or himself a “psychotherapist” or a “therapist.”

· Social Worker — Some social workers have a bachelor's degree (B.A., B.S.W., or B.S.), however most social workers have earned a master's degree (M.S. or M.S.W.). In most states social workers can take an examination to be licensed as clinical social workers. Social workers provide different forms of psychotherapy.

· Psychologist — Some psychologists possess a master's degree (M.S.) in psychology while others have a doctoral degree (Ph.D., Psy.D, or Ed.D) in clinical, educational, counseling, developmental or research psychology. Psychologists are licensed by most states. Psychologists can also provide psychological evaluation and treatment for emotional and behavioral problems and disorders. Psychologists can also provide psychological testing and assessments.

· Psychiatrist — A psychiatrist is a physician, a medical doctor, whose education includes a medical degree (M.D. or D.O.) and at least four additional years of study and training. Psychiatrists are licensed by the states as physicians. Psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in psychiatry. Psychiatrists provide medical/psychiatric evaluation and treatment for emotional and behavioral problems and psychiatric disorders. As physicians, psychiatrists can prescribe and monitor medications.

· Child and Teen Psychiatrist — A child and teen psychiatrist is a licensed physician (M.D. or D.O.) who is a fully trained psychiatrist and who has two additional years of advanced training beyond general psychiatry with kids, teens and families. Child and teen psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology become board certified in child and teen psychiatry. Child and teen psychiatrists provide medical/psychiatric evaluation and a full range of treatment interventions for emotional and behavioral problems and psychiatric disorders. As physicians, child and teen psychiatrists can prescribe and monitor medications.

Moms & dads should try to find a mental health professional who has advanced training and experience with the evaluation and treatment of kids, teens, and families. Moms & dads should always ask about the professionals training and experience. However, it is also very important to find a comfortable match between your youngster, your family, and the mental health professional.

Understanding Your Mental Health Insurance—

Insurance benefits for mental health services have changed a lot in recent years. These changes are consistent with the nationwide trend to control the expense of health care. It is important to understand your mental health care coverage so that you can be an active advocate for your youngster's needs within the guidelines of your particular plan. Here are some useful questions to ask when evaluating the mental health benefits of an insurance plan or HMO:

· Are there limits on the number of visits? Will my provider have to send reports to the managed care company?

· Do I have to get a referral from my youngster's primary care physician or employee assistance program to receive mental health services?

· Does the plan exclude certain diagnoses or pre-existing conditions?

· Does the plan have a track record in your area?

· Is there a "lifetime dollar limit" or an "annual limit" for mental health coverage, and what is it?

· Is there a "preferred list of providers" or "network" that you must see? Are child psychiatrists included? What happens if I want my youngster to see someone outside the network?

· Is there an annual deductible that I pay before the plan pays? What will I actually pay for services? What services are paid for by the plan: office visits, medication, respite care, day hospital, inpatient?

· What can I do if I am unhappy with either the provider of the care or the recommendations of the "utilization review" process?

· What hospitals can be used under the plan?

Managed care refers to the process of someone reviewing and monitoring the need for and use of services. Your insurance company may do its own review and monitoring or may hire a "managed care company" to do the reviewing. The actual review of care is commonly known as "utilization review" and is done by professionals, mostly social workers and nurses, known as "utilization reviewers" or "case managers." The child psychiatrist treating your youngster may have to discuss the treatment with a reviewer in order for the care to be authorized and paid for by your insurance. The reviewers are trained to use the guidelines developed by your health care plan. A review by a child and teen psychiatrist reviewer usually must be specially requested.

The review process often takes place over the telephone. Written treatment plans may also be required. Some plans may require that the entire medical record be copied and sent for review. Reviewers usually authorize payment for a limited number of outpatient sessions or a few days of inpatient care. In order for additional treatment to be authorized, the psychiatrist must call the reviewer back to discuss the youngster's progress and existing problems. Managed care emphasizes short-term treatment with a focus on changing specific behaviors.

Preferred providers are groups of doctors, social workers, or psychologists, which your insurer has agreed to pay. If you choose to see doctors outside of this list (out of network caregivers), your insurer may not pay for the services. You will still be responsible for the bill. Similarly, care given in hospitals designated as "in network" is paid for by your insurance, while care given in hospitals "out of network" is usually not paid by your insurance and becomes your responsibility. Even when using preferred providers and in network hospitals, utilization reviewers still closely monitor treatment.

Another change is the variety of services and diagnosis paid for by different plans. In the past, only inpatient care and outpatient care was covered by insurance. Now, depending upon your particular plan, other services such as day hospital, home-based care, and respite care may also be covered. These lower cost services may offer advantages to inpatient hospitalization.

A limiting feature of some mental health care plans is a low lifetime maximum or a low annual dollar amount that can be used for mental health care (i.e., once this amount is used, plan coverage ends.) You, as mother or father or guardian, are responsible for paying the non-covered bill. If your youngster/teen needs continued care, you may need to seek help from your state public mental health system. This usually means changing doctors, which may disrupt your youngster's care.

It is important to understand as much as possible about your particular insurance plan. Understanding your coverage will put you in a better position to help your youngster. Sometimes you may need to advocate for services that are not a part of your plan, but which you and your child's psychiatrist feel are necessary. Advocacy groups may provide you with important information about local services. The support of other moms & dads is also useful and important when engaged in advocacy efforts.

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